Tuberculum sellae meningioma¹⁾

Anterior communicating artery aneurysm

The unilateral subfrontal approach provides an en face and panoramic view of the anterior communicating artery region while limiting the risk of bifrontal injury attendant in a true interhemispheric approach or bilateral subfrontal approach. Often this obviates the need for gyrus rectus resection, although when a better view of the aneurysm is desired, we can resect only a small portion of gyrus rectus, but even in these cases the impression is that this amount of gyrus rectus resection is reduced compared to the standard pterional approach.

Petraglia et al. also feel this makes the final dissection in cases of ruptured lesions safer, often facilitates early A1 segment exposure and, consequently, proximal control. In those cases where the internal carotid segment is relatively short, the A1 segment often is readily exposed without needing to dissect the bifurcation, and in these cases no gyrus resection may be necessary. Nonetheless, the topic of gyrus rectus resection continues to generate controversy, they have no way of comparing the extent of resection in his patient cohort to that of other reported series, but as many others have noted, unilateral resection does not seem to cause significant neurologic consequences ²⁾